| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA, INC. | 1855 W. STATE ROAD 434 LONGWOOD, FL 32750 | KAISER FOUNDATION HEALTH PLAN INC. | $28K | — | $28K | 3.62% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | KAISER FOUNDATION HEALTH PLAN INC. | $13K | — | $13K | 1.63% |
| REUBEN WARNER ASSOCIATES, INC.3 Filed as: WARNER PACIFIC INS. SERVICES, INC. | 32110 AGOURA ROAD WESTLAKE VILLAGE, CA 91361 | KAISER FOUNDATION HEALTH PLAN INC. | -$18K | — | -$18K | -2.39% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC. | 130 VANTIS, SUITE 250 ALISO VIEJO, CA 92656 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $3K | $1K | $4K | 14.95% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | — | $1K | 4.55% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC. | 1855 W. STATE RAOD 434 LONGWOOD, FL 32750 | SAFEGUARD HEALTH PLANS, INC | $2K | $775 | $2K | 15.48% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | SAFEGUARD HEALTH PLANS, INC | $82 | — | $82 | 0.55% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC. | 130 VANTIS, SUITE 250 ALISO VIEJO, CA 92656 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $397 | $2K | 12.59% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $740 | — | $740 | 5.20% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC. | 130 VANTIS, SUITE 250 ALISO VIEJO, CA 92656 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $1K | $473 | $2K | 14.78% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $496 | — | $496 | 4.73% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC. | 130 VANTIS, SUITE 250 ALISO VIEJO, CA 92656 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $849 | $143 | $992 | 12.16% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $374 | — | $374 | 4.59% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC. | P.O. BOX 162207 ALTAMONTE SPRINGS, FL 32716 | PRINCIPAL LIFE INSURANCE COMPANY | $754 | — | $754 | 11.48% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | PRINCIPAL LIFE INSURANCE COMPANY | $303 | — | $303 | 4.61% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC. | 1855 W. STATE ROAD 434 LONGWOOD, FL 32750 | METROPOLITAN LIFE INSURANCE COMPANY | $616 | $329 | $945 | 17.18% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | METROPOLITAN LIFE INSURANCE COMPANY | $43 | — | $43 | 0.78% |
| INSURANCE OFFICE OF AMERICA3 Filed as: INSURANCE OFFICE OF AMERICA INC. | 130 VANTIS, SUITE 250 ALISO VIEJO, CA 92656 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $434 | $116 | $550 | 11.51% |
| ASSUREDPARTNERS3 Filed as: JMB INSURANCE AGENCY INC. | 900 N. MICHIGAN AVE., SUITE 1500 CHICAGO, IL 60611 | UNITED OF OMAHA LIFE INSURANCE COMPANY | $283 | — | $283 | 5.92% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 286 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 0 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 286 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | KAISER FOUNDATION HEALTH PLAN INC. | 167 | $768K |
| Dental(2 contracts, 2 carriers) | SAFEGUARD HEALTH PLANS, INC | 74 | $22K |
| Vision | METROPOLITAN LIFE INSURANCE COMPANY | 56 | $6K |
| Life insurance(2 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 286 | $25K |
| Short-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 31 | $8K |
| Long-term disability | UNITED OF OMAHA LIFE INSURANCE COMPANY | 286 | $25K |
| Prescription drug | KAISER FOUNDATION HEALTH PLAN INC. | 167 | $768K |
| Other(3 contracts) | UNITED OF OMAHA LIFE INSURANCE COMPANY | 286 | $30K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 286 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.